Reason and Passion in Bioethics

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Science  20 Dec 2002:
Vol. 298, Issue 5602, pp. 2335
DOI: 10.1126/science.1078916

Life, Liberty and the Defense of Dignity The Challenge for Bioethics

Leon R. Kass

Encounter Books, San Francisco, 2002. 319 pp. $26.95. ISBN 1-893554-55-4.

Bioethics may not have been around for long, but Leon Kass believes that it is already in decline, if not corrupt. He holds that although the thinkers who began modern bioethics—the theologian Paul Ramsey, the philosopher Hans Jonas, the bioethicist Dan Callahan, and others—had “vision, courage and moral passion,” they have been succeeded by rationalistic problem solvers who are “incapable of contributing to the increase or renewal of the needed moral capital or the passionate pursuit of wisdom.” In his view, we are “adrift without a compass”; do not know whether we are living through progress, change, or decline; and are unaware that “technology as a way of life is doomed.” Small wonder that in Life, Liberty and the Defense of Dignity, Kass notes “the rise of professional bioethics may have been good for bioethicists” but asks “how good has it been for our ethics?”

Kass, who is a professor in the University of Chicago's Committee on Social Thought and the chair of President George W. Bush's Council on Bioethics, offers a passionate polemic against current ways of thinking about reproductive technologies, uses of human tissues, and end-of-life medicine. Some of his criticisms are well aimed. Bioethics has had more than its share of poor arguments, sensationalism, sentimentality, and tenuous interdisciplinarity. Some of its favorite terms—consent and autonomy, risk and precaution, for example—are commonly used without arguments that show why, when, for what purposes, and under what interpretations they are important.

But is the remedy to these ills to affirm “the deepest issues of humanity” and “the ethics of human life as humanly lived”? And what exactly does such an affirmation affirm? Unlike many previous critics of contemporary bioethics, Kass does not appeal to the sanctity of life, or to a conception of the natural, but to notions of dignity and humanity. These venerable notions have been understood in many ways and invoked in support of various conclusions. Some conceptions of dignity, including those invoked in human rights documents and constitutions, see it as intrinsic to all humans; others see it as achieved by living in a certain way. On the former view, human dignity renders all human life sacrosanct, and those who invoke a “right to life” are not far off track. On the latter view, dignity is a matter not of keeping people alive but of their enjoying a certain sort of life: “death with dignity” may be preferred even at the expense of the sanctity of life.

Kass's substantive ethical views form a recognizable cluster: he is not against science, but against the technologizing of human life. He thinks that reproductive technologies should be judged in the light of our “idea of humanness, of our human life and the meaning of our embodiment, our sexual being, and our relation to our ancestors and descendants.” He disputes supposed “rights” to reproduce and to have genetically enhanced or reproductively cloned children. He argues that all uses of human tissues should heed “the deep wisdom of the sentiments” by shunning the coarseness of the transplantation culture, the degradations of organ sales, and the commodification of human flesh. He condemns appeals to a supposed “right to die” and its supporters who “hitch their deadly purpose to the autonomy movement.”

Yet Kass offers disconcertingly few arguments for these passionately and eloquently presented ethical views. He clearly derides postmodernism and relativism, yet seems sufficiently paralyzed by their joint onslaught to settle for persuasion rather than argument. He throws doubt and scorn on attempts at reasoning in bioethics. Lamenting bioethics that engages with “philosophical theorizing,” he criticizes bioethicists for succumbing to the standards of analytic philosophy. (We should be so lucky!)

Although Kass does not close in on the most fundamental shortcomings of the positions that he rejects, I believe he accurately identifies a number of them. Contemporary conceptions of autonomy that supposedly ground “patient rights,” “rights to reproduce,” and “rights to die,” are indeed shallow, and many of the arguments in favor of these “rights” are unsound. Yet if we are to dismiss those arguments, we need to pay them close attention. Kass unfortunately identifies appeals to autonomy with appeals to mere willfulness. Thus he neglects the enormous role that conceptions of “rational autonomy” play in contemporary bioethics as well as the reasons why this autonomy may also be a poor basis for bioethics. If we are to move to more robust arguments for alternative views, such as those that center on dignity rather than autonomy, we must dig deeper. We need to understand what is awry in the passion for autonomy and complacency about the rights culture that dominate contemporary bioethics. To my way of thinking, Kass does not travel nearly far enough along this road. The exponents of dignity may eventually have the edge over the proponents of autonomy, but to date their arguments are (if anything) less secure.

In the end, even a sympathetic reader who shares a fair number of Kass's ethical views will hanker for more than a jeremiad—even a well-informed, well-written one such as Life, Liberty and the Defense of Dignity. Just as reform always requires a long march through the institutions, so rethinking fundamentals needs a long march through the arguments.

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